PB0431 - Anticoagulant therapy for splanchnic vein thrombosis: an individual patient data meta-analysis

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Matteo Candeloro, MD

Specialist
"G. D'Annunzio" University
Chieti, Abruzzi, Italy

Co-Author(s)

EV

Emanuele Valeriani

MD
Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Italy
Rome, Lazio, Italy
MM

Manuel Monreal

MD PhD
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
Barcelona, Andalucia, Spain
Walter Ageno, MD

Professor of Medicine
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
NR

Nicoletta Riva, MD, PhD

MD
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Msida, Malta
RL

Raquel Lopez-Reyes

Senior consultant
Hospital La Fe
Valencia, Comunidad Valenciana, Spain
MP

Maria Luisa Peris

MD
Department of Pneumonology. Hospital Universitari i Politècnic La Fe. Valencia. Spain.
Castellón, Comunidad Valenciana, Spain
JB

Jan Beyer-Westendorf

MD, Head of Division of Thrombosis & Hemostasis
Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, Dresden, Germany
Dresden, Sachsen, Germany
Sam Schulman, MD, PhD

MD, PhD
Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
Hamilton, Ontario, Canada
VR

Vladimir Rosa

MD
Department of Internal Medicine. Hospital Universitario Virgen de Arrixaca. Murcia. Spain
Murcia, Murcia, Spain
JL

Juan José López-Núñez

Head
Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
Barcelona, Catalonia, Spain
JG

Juan Carlos Garcia-Pagan

MD
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD. University of Barcelona, Barcelona. Spain
Barcelona, Catalonia, Spain
MM

Marta Magaz

MD
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD. University of Barcelona, Barcelona. Spain
Barcelona, Catalonia, Spain
MS

Marco Senzolo

MD
Multivisceral Transplant Unit, University Hospital of Padua, Padua, Italy
Padova, Veneto, Italy
AD

Andrea De Gottardi

MD
Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
Lugano, Ticino, Switzerland
MD

Marcello Di Nisio

MD
Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
Chieti, Abruzzi, Italy

Background: Robust evidence on the optimal management of splanchnic vein thrombosis (SVT) is lacking and guideline recommendations are heterogeneous.

Aims: To evaluate the effectiveness and safety of anticoagulation for SVT.

Methods: This individual patient data meta-analysis was performed according to the PRISMA guideline. We searched MEDLINE and EMBASE up to June 2021 and clincaltrial.gov. Data from individual datasets were verified, merged, and any discrepancy with published data was resolved by contacting study authors. Main effectiveness outcomes were recurrent venous thromboembolism (VTE) and mortality; the main safety outcome was major bleeding. Incidence rates were expressed as number of events per 100 patient-years (/100 p-y) with relative 95% confidence intervals (95% CI). Hazard ratios (HRs) were estimated with Cox proportional models considering anticoagulant treatment as time-varying.

Results: A total of 1635 patients were included from 3 studies. Eighty-five percent of patients received anticoagulation for a median duration of 316 days (range 1 to 730 days). Overall, incidence rates for recurrent VTE, major bleeding, and mortality were 5.3/100 p-y (95% CI, 5.1 to 5.5), 4.4/100 p-y (95% CI, 4.2 to 4.6), and 13.0/100 p-y (95% CI, 12.4 to 13.6), respectively. The incidence rates of all outcomes were lower during anticoagulation and higher after treatment discontinuation or when anticoagulation was not administered. In multivariable analysis, anticoagulant treatment appeared to be associated with a lower risk of recurrent VTE (HR 0.42; 95% CI, 0.27 to 0.64), major bleeding (HR 0.48; 95% CI, 0.30 to 0.75), and mortality (HR 0.23; 95% CI, 0.18 to 0.31). Results were consistent in patients with cirrhosis, solid cancer, myeloproliferative neoplasms, unprovoked SVT, and SVT associated with transient or persistent non-malignant risk factors.

Conclusion(s): In patients with SVT the risk of recurrent VTE and major bleeding is substantial. Anticoagulant treatment is associated with reduced risk of both outcomes.